You have just breathed the sigh of relief that all the changes are well-maintained and you have everything streamlined. Well, it seems Medicare and Medicaid Services are in no mood to let you settle down. It was only recently they have again come up with some new altercations and changes which require updating coding that will need changes in your present medical billing as well. This means a proposed 1,900 new diagnosis medical codes for small practices to begin using by fiscal year 2017 and so on.
Outsource medical billing service company must comply with an abundance of federal and state regulations to remain operating, including medical billing laws. Medical facilities handle the business aspects of the healthcare industry, as well as the health of the individuals they serve. These facilities have a responsibility to act within the ethical standards of healthcare practice.
All providers need a collections process to ensure the financial health of their practice. A medical billing service company should establish a step-by-step approach with the practitioner who clarifies the procedures for all involved, and it can greatly improve revenue cycles of a practitioner by ensuring patients are properly and thoroughly informed of their responsibilities.
A rejected claim is one that hasn’t been processed yet due to the discovery of one or more errors. It’s preventing the insurance company from paying the bill as it’s written. A denied claim, on the other hand, is a claim that the insurance company has processed and has deemed unpayable due to a discovered violation of the payer-patient contract or some vital error caught after processing. In both of these cases, the payer will return the claim to the biller with an explanation of the problem.
A rejected claim can be corrected and resubmitted, and this exercise can be tactfully handled if your outsource medical billing service company is updated and have expertise, knowledgeable staff to handle the same. If you are using software from a 3rd party medical billing service company; this too can be eliminated if it comes with the equipped feature with the regular updates and latest regulations.
Within a claim, medical coders describe the performed procedures using standardized codes, making the claims easier to decipher and process. These codes can use ICD-10-CM, CPT and HCPCS Level II classification systems.
While this provides a standard method of describing procedures, errors can still occur. The most common errors, such as incorrect, mismatched, or missing codes, are often caught by clearinghouses before they become an issue. However, some common errors are more difficult to catch. These errors include:
Checking for errors in a claim can minimize the occurrence of rejections and denials, but if they do occur, be sure to handle them as quickly as possible. Medical billing service company can reduce this exercise by keeping in touch with a representative of the payer — they can help clarify problems with the original claim and provide information on current claims as they are processed. All of this can help expedite the claim editing process and minimize appeal and resubmission times.
The medical healthcare field is constantly changing, and physician practices should follow suit if they want to maximize efficiency and revenue. By tracking performance and keeping current on the latest healthcare regulations, practices can identify problem areas and implement new ways of addressing them.
To ensure optimum efficiency and accuracy, outsourcing medical billing service company should take the following steps:
Stay informed: Medical billing rules are constantly changing and keeping up with these changes can require continuing education and training for staff, as well as software updates. Stay on top of any changes that may affect billing and coding protocols and seek training if necessary — this is less costly in the long run than repeatedly resubmitting claims.
Medical practices must constantly worry about their patients, current trends in medicine and proper staff management. They must also stay current with the most recent rules about coding standards, insurance companies, and billing regulations. With so much to keep up with, details can slip through the cracks, resulting in rejections, denials, and underpayments that cost medical practices time and money.
In response to the multiplying rules and regulations and in an effort to cut labor costs, many practices have outsourced their medical billing to the top medical billing service company. For many, it’s an effective way to increase revenue and regain control over their billing.